title: Breast cancer surgery volume-cost associations: hierarchical linear regression and propensity score matching analysis in a nationwide Taiwan population.
abstract: BACKGROUND
  No outcome studies have longitudinally and systematically compared the effects of hospital and surgeon volume on breast cancer surgery costs in an Asian population. This study purposed to evaluate the use of hospital and surgeon volume for predicting breast cancer surgery costs.
  
  
  METHODS
  This cohort study retrospectively analyzed 97,215 breast cancer surgeries performed from 1996 to 2010. Relationships between volumes and costs were analyzed by propensity score matching and by hierarchical linear regression.
  
  
  RESULTS
  The mean breast cancer surgery costs for all breast cancer surgeries performed during the study period was $1485.3 dollars. The average breast cancer surgery costs for high-volume hospitals and surgeons were 12% and 26% lower, respectively, than those for low-volume hospitals and surgeons. Propensity score matching analysis showed that the average breast cancer surgery costs for breast cancer surgery procedures performed by high-volume hospitals ($1428.6 dollars) significantly differed from the average breast cancer surgery costs of those performed by low-/medium-volume hospitals ($1514.0 dollars) and that the average breast cancer surgery costs of procedures performed by high-volume surgeons ($1359.0 dollars) significantly differed from the average breast cancer surgery costs of those performed by low-/medium-volume surgeons ($1550.3 dollars) (P < 0.001).
  
  
  CONCLUSIONS
  The factors significantly associated with hospital resource utilization for this procedure included age, surgical type, Charlson co-morbidity index score, hospital type, hospital volume, and surgeon volume. The data indicate that analyzing and emulating the treatment strategies used by high-volume hospitals and by high-volume surgeons may reduce overall breast cancer surgery costs.
authors.affiliation: Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung 807, Taiwan.
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
authors.forename: Hong-Tai
authors.initials: HT
authors.lastname: Chang
authors.forename: Richard
authors.initials: R
authors.lastname: Culbertson
authors.forename: Yi-Jheng
authors.initials: YJ
authors.lastname: Chen
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Liao
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Hou
mesh_terms: D001943:Breast Neoplasms / Q000191:economics* / Q000453:epidemiology / Q000601:surgery; D005260:Female; D006801:Humans; D016014:Linear Models; D008408:Mastectomy / Q000191:economics*; D057216:Propensity Score; D013624:Taiwan / Q000453:epidemiology
keywords: Breast cancer surgery; Cost; Taiwan; Volume